Violence Against Women: G lobal Maternal/Reproductive Health Burden and Promising Solutions Jay G. Silverman, Ph.D. Professor Of Medicine And Global Health Co-Director, Program on Gender Inequities and Global Health

State of Knowledge and Examples of Promising Programs Prevalence of IPV - 25%-75% (Garcia-Moreno et al., 2006) Control of Conception Health During Pregnancy Pregnancy Outcomes Infant and Child health Promising Programs

State of Knowledge: VAW and Control of Conception Contraception - Married women less likely to adopt, Abusive men less likely to use (Stephenson et al., 2008; Decker et al., 2011) Pregnancy coercion – 83% more likely (Miller and Silverman et al., 2010) Unintended pregnancy - 46% to 69% increased risk (Pallitto et al, 2012; Cripe et al., 2008; Silverman et al, 2007) Abortion - 61% to 2.7 times more likely Repeat Abortion – 2.2 to 3.4 times more likely (Pallitto et al., 2012; Nguyen et al., 2012; Silverman et al, 2010)

State of Knowledge: VAW and Poor Pregnancy Health First trimester antenatal care – 34-53% less likely (Koski et al 2011; Silverman et al., forthcoming) Health during pregnancy No weight gain - 95% more likely (Silverman et al., forthcoming) Preeclampsia – 47% to 2.7 times more likely (Sanchez et al., 2008; Silverman et al., forthcoming) PROM - 62% to 2.1 times more likely (Silverman et al., 2005, forthcoming)

State of Knowledge: VAW and Poor Pregnancy Outcomes Poor pregnancy outcomes Miscarriage – 1.8 times more likely (Silverman et al., 2007) Preterm delivery – 37% to 2.0 times more likely (Silverman et al., 2006; Sanchez et al., 2013) Maternal Mortality?

State of Knowledge: VAW and Child Health Low Birth Weight - 17% to 3.9 times more likely (Valledares et al, 2002; Silverman et al., 2006, forthcoming) Diarrheal Disease and Acute Respiratory Infection – 38% to 65% more likely (Silverman et al., 2009, forthcoming) Malnutrition and Stunting - 34% to 36% more likely (Ackerman and Subramanian, 2008; Rico et al., 2011; Salazar et al., only for girls) Infant Death - 15% to 85% more likely (Jejeebhoy, 1998; Koenig et al, 2010; Rico et al., 2011; Silverman et al, 2011 – only for girls)

Counseling Households to Improve Antenatal Care, Nutrition, Communication and Equity: CHANCE Partners: Indian NIRRH and Population Council Government-funded health promotion includes multiple household visits by CHWs CHANCE expands model by: including husbands and in-laws integrating negative health impacts of husband violence and household maltreatment (3) minute education/counseling visits over six weeks integrated into standard gov’t programs

CHANCE Pilot Improved Utilization of antenatal care Marital communication with husbands re: pregnancy) Reduced Fear of husbands Household maltreatment (e.g., increased access to nutrition and rest) Violence from husbands against pregnant women 2-arm cluster RCT, N=240 families (NICHD/ICMR:Pending)

Ending Reproductive Coercion A Family Planning-based Program Training of existing FP counselors Provide brief intervention within SoC to: Recognize connections between VAW and reproductive control Reduce harm via strategic contraception Connect to available VAW services RCT results (N=906, 12 mo. follow-up; NICHD): 71% reduced risk of pregnancy coercion 63% increase in leaving a relationship re: abuse (Miller and Silverman et al., 2011)

VAW is a major factor in maternal/reproductive health. Interventions can reduce VAW and improve maternal and child outcomes. Rigorously Assess, Adapt and Scale